April 03, 2013

Thirty-three years following enactment of the Medicare Secondary Payer (MSP) Act and 12 years after the Centers for Medicare and Medicaid Services (CMS) issued its first workers compensation Medicare set-aside (WCMSA) memorandum, CMS has finally published a WCMSA Reference Guide (WCRG).

Enacted in 1980, the MSP Act requires
certain insurers, including liability, automobile, no-fault and workers
compensation insurers, to make payment first for services to Medicare
beneficiaries regarding claimed injuries, with Medicare responsible only
as a “secondary payer.”

CMS,
the agency responsible for administering Medicare policies, failed to
take practical steps to enforce the MSP rules until 2001 when it issued
the first of several policy memorandums addressing WCMSAs. These policy memorandums created a format, checklists and procedures for seeking approval for WCMSAs to "protect Medicare's interests" when workers compensation cases are settled. The WCRG states: "The WCRG follows all CMS policy memorandums currently in effect. The memorandums are published on the CMS website."

Although CMS and its field offices have also issued informal guidance about the use of MSAs in liability cases,
nothing comparable exists to the CMS WCMSA memoranda. As a result,
there is no uniform position or consensus among tort practitioners as to
whether and when MSAs are required in liability cases.

The WCRG continues a series of Medicare legislative and regulatory compliance initiatives which also include the Medicare, Medicaid and SHIP Extension Act (MMSEA) and the Strengthening Medicare and Repaying Taxpayers Act (SMART Act).

Published by CMS on March 29, 2013, the 88-page WCRG(including Appendices) applies only to workers compensation cases. Its intended purpose: to help WCMSA professionals, beneficiaries and other stakeholders "understand
CMS' [WCMSA] amount approval process and to serve as a reference for
those electing to submit such proposals to CMS for approval."

"Any
claimant who receives a WC settlement, judgment,or award that includes
an amount for future medical expenses must take Medicare’s interest with
respect to future medicals into account."

"If
Medicare’s interests are not considered, CMS has a priority right of
recovery against any entity that received a portion of a third party
payment either directly or indirectly."

"Medicare may also refuse to pay for future medical expenses related to the WC injury until the entire settlement is exhausted."

Compromises:"CMS does not compromise or reduce future medical expenses related to a WC injury."

WCMSA statutes and regulations:"There are no statutory or regulatory provisions requiring that you submit a WCMSA amount proposal to CMS for review."

What are WCMSAs:"A WCMSA allocates a portion of the WC settlement for all future
work-injury-related medical expenses that are covered and otherwise
reimbursable by Medicare. When a proposed WCMSA amount is submitted to
CMSfor review and the individual or beneficiary obtains CMS’approval,
the CMS-approved WCMSA amount must be appropriately exhausted before
Medicare will begin to pay for care related to the beneficiary’s
settlement, judgment, award, or other payment."

Benefit of WCMSA:"The
primary benefit [of submitting a WCMSA] is the certainty associated
with CMS reviewing and approving the proposed amount with respect to the
amount that must be appropriately exhausted."

Goal of WCMSA:"The
goal of establishing a WCMSA is to estimate, as accurately as possible,
the total cost that will be insured for all medical expenses otherwise
reimbursable by Medicare for work-related conditions during the course
of the claimant’s life, and to set aside sufficient funds from the
settlement, judgment,or award to cover that cost."

Creating a WCMSA:"Generally there are four steps involved in creating a CMS-approved WCMSA:

"Analysis of the claim and medical information in order to determine the amount of money required for the fund.

"Negotiation
of a tentative settlement and preparation of draft settlement documents
to settle the WC case incorporating terms for creation and
administration of the WCMSA (CMS is not a party to the settlement).

"Obtaining approval from CMS regarding the settlement and the proposed WCMSA.

"Finalizing the settlement and funding the WCMSA."

WCMSA funding:

"CMS has no process to accept up-front cash payments in lieu of a CMS reviewed WCMSA."

"WCMSAs
may be funded by a lump sum or may be structured, such that a fixed
amount of funds are provided each year for a fixed number of years."

CMS Review of WCMSAs - excluding structured settlement and rated age issues which S2KM will be address in subsequent blog posts.

Introductory note: CMS introduced a WCMSA internet portal in November 2011 for submission of WCMSA proposals.

Review threshold:"CMS will review a proposed WCMSA amount when the following workload review thresholds are met:

"The claimant is a Medicare beneficiary and the total settlement amount is greater than $25,000.00; or

"The
claimant has a reasonable expectation of Medicare enrollment within 30
months of the settlement date and the anticipated total settlement
amount for future medical expenses and disability/lost wages over the
life or duration of the settlement agreement is expected to be greater
than $250,000.00."

"A claimant has a reasonable expectation of Medicare enrollment within 30 months if any of the following apply:

"The claimant has applied for Social Security Disability Benefits.

"The claimant has been denied Social Security Disability Benefits but anticipates appealing that decision.

"The claimant is in the process of appealing and/or re-filing for Social Security Disability benefits.

"The claimant is 62 years and 6 months old.

"The claimant has an End Stage Renal Disease (ESRD) condition but does not yet qualify for Medicare based upon ESRD."

Review not required:"It
is unnecessary for the individual or beneficiary to obtain CMS approval
for a proposed WCMSA amount if all of the following are true:

"The facts of the case demonstrate that the injured individual is only being compensated for past medical expense

"There
is no evidence that the individual is attempting to maximize the other
aspects of thesettlement (e.g., the lost wages and disability portions
of the settlement) to Medicare’s detriment; and

"The
individual's treating physicians conclude (in writing) that to a
reasonable degree of medical certainty the individual will no longer
require any Medicare-covered treatments related to the WC injury.
However, if Medicare made any conditional payments for WC-related
services furnished prior to settlement, then Medicare will recover those
payments. In addition, Medicare will not pay for any WC-related
services furnished prior to the date of the settlement for which it has
not already paid."

Review process:

"If
you choose to use CMS’ WCMSA review process, the Agency requests that
you comply with CMS 'established policies and procedures."

"When
a WCMSA is submitted for approval, CMS must have certain documentation
available to complete a review of the proposal. Table 1 lists the
documents normally submitted with a WCMSA proposal."

"Submit
the gross total settlement amount as a single lifetime number and NOT
the settlement amount minus attorney fees, expenses, etc."

"Once
this information is received, the COBC will apply it to the
beneficiary's Medicare record and assign the case to the Medicare
Secondary Payer Recovery Contractor (MSPRC)."

"The
MSPRC will send the beneficiary a “Rights and Responsibilities” letter
that explains Medicare's recovery rights with respect to conditional
payments and information regarding what steps the beneficiary should
take next."

"Once the Rights and Responsibilities letter is received, all further inquiries must be made through the MSPRC."

"If
the parties to a WC settlement stipulate a WCMSA but do not receive CMS
approval, then CMS is not bound by the set-aside amount stipulated by
the parties, and it may refuse to pay for future medical expenses in the
case, even if they would ordinarily have been covered by Medicare."

"If
CMS approves the WCMSA and the account is later appropriately
exhausted, Medicare will pay related medical bills for services
otherwise covered and reimbursable by Medicare regardless of the amount
of care the beneficiary continues to require."

"You can
see your case’s status on the WCMSAP, if the case was submitted on the
Portal. For cases that were submitted via mail, case status can be
obtained by contacting the WCRC."

"When CMS does not
believe that a proposed set-aside adequately protects Medicare’s
interests,and thus makes a determination of a different amount than
originally proposed, there is no formal appeals process. However, there
are several other options available."

Life Care Plans

"A
Life Care Plan is a dynamic document based on published standards of
practice, comprehensive assessment, data analysis, and research that
provides an organized concise plan for current and future needs with
associated costs for individuals who have experienced catastrophic
injury or have chronic health needs."

"A life care plan
is appropriate when the claimant’s injury or disease is extensive and
serious, e.g., paraplegia, quadriplegia, brain damage."

"Although
submission of a life care plan is optional, you are required to include
drug and dosage lists. Include all pricing charts, cost projections,
pricing information, and explanatory narratives and analyses."

"When
the parties to a WC settlement present CMS with “life care plans” or
similar evaluations prepared by non-treating physicians to support and
justify their proposed WCMSAs, Medicare will consider accepting such
evaluations if the physician does all of the following:

"Examines the claimant;

"Reviews the claimant's medical records;

"Contacts any of the claimant's treating physicians (if applicable);

"Is available to answer CMS’ questions;

"Prepares a report that summarizes the above; and

"Offers
a written medical opinion as to all of the reasonably anticipated
future medical needs of the claimant related to the claimant's work
injury or illness/disease."

Future Treatment

"Determine
the cost of future medical expenses that are directly related to the
injury or illness suffered by the worker. This amount can be determined
by reviewing medical records and past medical expenditures. The WCMSA
must show the amount of money that should be invested to provide the
yearly expenses for the worker’s life expectancy."

"Note:
In order to protect Medicare’s interests, a WCMSA should be funded
based on the life expectancy of the claimant unless state law
specifically limits the length of time that WC covers work-related
conditions. The key is that both the principal amount that is to be set
aside and the anticipated interest that it will earn must be sufficient
to provide for the worker’s future medical treatment and administration
fees for the worker’s lifetime."

"Identify specific
types of medical services or items, the frequency and duration of the
medical services or items, and the projected costs of the medical
services or items related to the work injury or disease that are
expected in the future in light of the claimant's condition."

Time Frame

"When
you submit a WCMSA for review, CMS tries to review and decide on
proposed settlements within 45 to 60 days from the time that all
relevant documents are submitted."

"Parties to the
settlement may settle the indemnity (non-medical-expenses) portion of
the claim separately from the WCMSA portion, in order to avoid having
indemnity payments continue while CMS is still reviewing the proposal.
CMS will still consider the whole claim, including indemnity, in its
threshold calculations."

Administration

"Once a WCMSA is established and funded, it must be administered."

"This can be done by the claimant, by the claimant’s representative
payee, appointed guardian, or conservator, or by a professional
administrator."

"The administrator of the account will be responsible for keeping accurate records of payments made from the account."

"The administrator must establish the WCMSA account, pay Medicare-covered
services from the WCMSA account, and provide CMS with a reporting of
the expenditures from the WCMSA."

"Every
year, beginning no later than 30 days after the 1-year anniversary of
settlement the administrator must sign and send a statement that
payments from the WCMSA account were made for Medicare-covered medical
expenses and Medicare-covered prescription drug expenses related to the
work-related injury, illness, or disease."

Death of the Claimant

"If
a claimant dies before the WCMSA is completely exhausted, the [Regional
Office] and [Medicare Secondary Payer Recovery Contractor] will ensure
that all claims have been paid."

"Then any amount left over in the WCMSA may be disbursed pursuant to state law, once Medicare’s interests have been protected."

"This
may involve holding the WCMSA open for some period after the date of
death, as providers, physicians, and other suppliers are permitted to
submit their initial bill to Medicare for a period of 12 months after
the date of service."

"Often, the settlement itself will dictate the appropriate dispersal of funds up on the death of the claimant."

For additional S2KM reporting about government benefit issues, see the structured settlement wiki. For analysis of the interaction of structured settlements and government benefits, see Chapter 15 of "Structured Settlements and Periodic Payment Judgments" (S2P2J).

February 14, 2012

When is a structured settlement annuity appropriate for a specific physical personal injury claimant? And what standards exist to help judges, guardians, trustees, mediators, attorneys, settlement planners, structured settlement consultants and other structured settlement stakeholders make this determination?

In two prior blog posts, S2KM has addressed these issues in the context of:

Part 1 - NSSTA's Code of Ethics; SSP's Standards of Professional Conduct; and the NAIC's Suitability in Annuity Transactions Model Regulation.

This blog post discusses product suitability standards created by the Uniform Prudent Investor Act (UPIA) and the Dodd-Frank Wall Street Reform and Consumer Protection Act (Dodd-Frank) and highlights a general trend to create a more uniform fiduciary, and/or "best interest", standard of care to protect investors.

UPIA

When investing and managing assets (including settlement proceeds and structured settlement annuity payments), trustees historically have been held to a fiduciary standard. According to uslegal.com, "[A] fiduciary duty is an obligation to act in the best interest of another party..... A person acting in a fiduciary capacity is held to a high standard of honesty and full disclosure in regard to the client and must not obtain a personal benefit at the expense of the client." (emphasis added)

More recently and comprehensively, a trustee's investment responsibilities have been re-defined legislatively by the UPIA which was adopted by the National Conference of Commissioners on Uniform State Laws (NCCUSL) in 1994 and approved by the American Bar Association in 1995. The UPIA now serves as the most important reference, external to the trust document itself, for trustees to determine what fiduciary duties their position requires. With some state-specific modifications, 41 states, U.S. Virgin Island, and the District of Columbia have adopted the UPIA.

Prior to the UPIA, courts applied the "prudent man rule" when evaluating trustee investment performance. The prudent man rule required trustees “to observe how men of prudence, discretion and intelligence manage their own affairs, not in regard to speculation, but in regard to the permanent disposition of their funds, considering probable income, as well as the probable safety of the capital to be invested.”

The UPIA, by contrast, adopts "modern portfolio theory" as a different and more appropriate standard for trustees. Compared with the prudent man rule, modern portfolio theory promotes a holistic view of trust assets by focusing on the total return generated by a trust as opposed to viewing a trust's income and principal separately. By viewing all investments comprehensively, modern portfolio theory and the UPIA hold that a trustee (or other investor) can achieve a positive overall investment return despite the poor performance of specific investments. This new standard allows for greater investment diversification so long as the risk/reward ratio matches the purposes and terms of the trust instrument.

Section 2(c) of the UPIA identifies eight factors a trustee should consider when making any investment:

General economic conditions;

The possible effect of inflation or deflation;

The expected tax consequences of investment decisions or strategies;

The role that each investment or course of action plays within the overall trust portfolio;

The expected total return from income and appreciation of capital;

Other resources of the beneficiaries;

Needs for liquidity, regularity of income, and preservation or appreciation of capital; and

An asset’s relationship of special value, if any, to the purposes of the trust or to one or more of the beneficiaries.

Significant for structured settlement annuities, the UPIA's list of investment considerations fails to mention mental or physical disabilities of a trust beneficiary. From a settlement planning and/or special needs perspective, injuries or diseases that reduce an individual's normal life expectancy arguably should receive important consideration when a trustee makes investment decisions.

Dodd-Frank

President Obama signed Dodd-Frank into law on July 21, 2010. Among other reforms, this sweeping legislation created the Consumer Financial Protection Bureau (CFPB) and the Federal Insurance Office (FIO). CFPB's central mission is "to make markets for consumer financial products and services work for Americans ....." Among its core functions are addressing consumer complaints and restricting unfair, deceptive or abusive acts or practices under the Federal consumer financial laws. Dodd-Frank provides the CFPB with significant authority that goes beyond existing consumer protection statutes. CFPB has broad authority to ask questions and demand information including consumer complaints. The FIO is part of the U.S. Department of Treasury and has authority to monitor all aspects of the insurance industry.

In addition to creating the CFPB and the FIO, Dodd-Frank directed the Securities and Exchange Commission (SEC) to study the need for a new, uniform, federal fiduciary standard of care for broker-dealers and investment advisers and to apply such a uniform standard if it deemed necessary. The SEC's assignment also required determining the existence of any gaps, shortcomings, or overlaps in legal or regulatory standards for the protection of retail customers.

Historically, investment advisers and broker-dealers have been subject to differing standards of care. Investment advisers are defined under Federal law as persons who “engage in the business of advising others. . .as to the value of securities or as to the advisability of investing in, purchasing, or selling securities. . .” [15 U.S.C. § 80b-2] They are regulated under the Investment Advisers Act of 1940 and owe a fiduciary duty to their clients.

Broker-dealers are defined under Federal law as persons who engage in “the business of offering, buying, selling, or otherwise dealing or trading in securities. . .” [15 U.S.C. § 78b(12)] and may provide a variety of related services. Broker-dealers generally are not subject to any fiduciary duty under the federal securities laws. They do, however, have a duty of fair dealing which includes a “suitability” standard - i.e. broker-dealers must make recommendations that are consistent with the interests of their customers.

Adding further uncertainty for investors, the existing legislative and regulatory system, according to the Securities Industry and Financial Markets Association (SIFMA), also "leaves states free to develop their own often conflicting definitions of fiduciary standards. This can confuse investors and lead to inconsistent definitions and interpretations under existing state law." SIFMA has recommended adoption of a uniform definition of "fiduciary duty" applicable to broker-dealers and investment advisers that includes both a duty of care and a duty of loyalty. These duties, according to SIFMA, should require both broker-dealers and investment advisers "to act in the best interest of the customer, and to provide full and fair disclosure of material facts and conflicts of interest."

In January 2011, the SEC submitted its "fiduciary standard" study to Congress recommending the adoption of a uniform fiduciary standard for investment advisers and broker-dealers when providing investment advice to retail customers. The SEC's proposed standard would be “no less stringent” than the standard currently applicable to investment advisers, and would include the duty to act in the "best interest" of the customer.

Structured Settlement Annuities

Why are the UPIA and Dodd-Frank relevant and important for structured settlement stakeholders?

Structured settlement annuities increasingly are paid into trusts (UPIA) that also include financial securities (Dodd-Frank).

Settlement planners, as opposed to traditional structured settlement sales persons, are increasingly licensed to sell financial securities as well as insurance products.

To be successful in the changing financial and insurance environment, anyone selling structured settlement annuities must understand and compete against the highest product suitability standards and best business practices.

Given the diversity, uncertainty and transition of various product suitability standards, how should structured settlement stakeholders address the issue of whether a structured settlement is appropriate for individual physical personal injury claimants? S2KM will offer practical case-specific advice and strategic industry advice in its next blog post.

For additional information about structured settlement business standards and practices, see the structured settlement wiki and Section 6.02 of "Structured Settlements and Periodic Payment Judgments" (S2P2J).

March 27, 2011

Although no statutory or regulatory authority requires Medicare set-aside arrangements (MSAs) in third party liability settlements, confusion continues as to whether and when MSAs are necessary and/or appropriate for such cases.

Although their objectives and target audiences are different, the National Academy of Elder Law Attorneys (NAELA) and the American Bar Association (ABA) have each recently issued recommendations addressing MSAs and liability cases.

Although Federal law does no define MSAs, or mandate specific types of MSA funding mechanisms, CMS (the responsible federal agency) has established certain basic requirements for workers compensation MSAs (WCMSA) in a series of memoranda beginning in 2001:

In addition, the CMS WCMSA memoranda create both an advantage and a problem for using structured settlements to fund WCMSAs:

October 15, 2004 Memorandum - CMS sets forth a "set-off" method for calculating present value that establishes an inherent cost advantage for annuity funding as opposed to lump sum funding for many WCMSAs.

August 20, 2008 Memorandum - CMS encourages the submission of annuity quotes with rated ages to establish life expectancy with requirements that have proven burdensome for both structured settlement consultants and annuity providers.

Meanwhile, the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) requires liability insurers to determine the Medicare status for all claimants and to report all claims involving a Medicare beneficiary to CMS when those claims are resolved - or face a civil penalty of $1000 per day per unreported claim.

On November 9, 2010, CMS delayed the submission deadline for liability insurance claim reports from the first calendar quarter of 2011 to the first quarter of 2012.

MMSEA does not address the need for MSAs in liability cases and CMS has not offered any related uniform or formal guidance.

Within this confusing legal environment, where liability insurers and attorneys must still decide how best to comply with the MSP act in liability cases without over-reacting and establishing an MSA unnecessarily, NAELA and the ABA have each issued recent recommendations.

NAELA published its recommendations on October 27, 2010 as part of a Medicare Set-AsideTask Force Report approved by NAELA's Board of Directors. In addition to recommendations, the NAELA Task Force Report includes findings and legal resources. NAELA's recommendations are intended for special needs and elder law attorneys handling personal injury settlements involving the MSP program and include two caveats:

"The requirement for future medical expenses set-asides in tort cases is not as clear as it is in WC cases"; and

"Some Medicare regional offices will not consider MSP set-asides in tort cases. Cases in which the above advice should be communicated to clients should be limited to those cases with large settlement/awards based on specific estimates and evidence of the costs of future medical services."

S2KM summary of NAELA's recommendations:

Document any advice and counseling about the appropriateness of MSAs for specific cases.

Warn PI clients that the Medicare Secondary Payer Act (MSP) applies to all tort settlements and that CMS considers PI plaintiffs to have an obligation to protect Medicare's interests in coordinating future benefits.

Advise PI clients to consider MSAs with applications for approval to CMS in cases with large settlement/awards based on specific estimates and evidence of the costs of future medical services.

Be mindful under state law of an attorney's duty to protect a client’s liability recovery from incorrect claims and unnecessary charges.

The NAELA Public Policy Committee and Medicare Task Force should continue:

Unlike NAELA, the ABA recommendations, approved during the ABA's 2011 Midyear Meeting, are addressed to the United States Congress and urge Congress to amend the MSP Act. The ABA recommendations resulted from resolutions adopted by the ABA's Tort Trial and Insurance Practice Section (TIPS) which also included a list of historical findings:

"RESOLVED, That the American Bar Association urges Congress to acknowledge that there is no regulatory or statutory basis for Medical Set Asides for third party liability settlements, judgments or awards under the Medicare Secondary Payer Act and provide clear, predictable, and consistent procedures for the submission, uniform determination, and timely approval of any third party medical set aside settlement proposals (MSASP) voluntarily submitted to the Centers for Medicare & Medicaid Services (CMS) in response to the non-binding recommendations of CMS.

"FURTHER RESOLVED, that legislation to accomplish these goals should incorporate the following principles:

Acknowledge that there are not statutory and regulatory requirements for determining Medical Set Aside payments and the process for approving claims subject to the Medicare Secondary Payer Act for third party liability claims.

Exempt from review by CMS all settlements in which there are no legal obligations to pay medical benefits.

Establish an appeals process that must be completed by CMS within 690 days of request by the claimant, insurer, or their representative.

Prohibit CMS from seeking additional moneys from the settlement proceeds after review and/or appeals processes have been concluded.

Prohibit recovery thresholds for MSASP that are linked to predetermined economic indices.

Prohibit recovery thresholds for MSASP that are linked to predetermined economic indices.

Establish a 30 day deadline by which CMS must respond in writing of its acceptance of the proposed MSASP.

Require CMS to timely (“timely” means within 60 days the information must be delivered to the patient and patient’s lawyers) and reasonably provide a detailed list of any payments it made and/or may make a claim for set aside for, and if it does not, cannot collect or require a set aside for that patient.

Prohibit the “certification” or claim of specialization by any private individual or person or government entity of a process, practice or individual in the determination of MSASP.

Prohibit the use of Social Security numbers and Health Card Numbers in the MSASP reporting process."

March 17, 2011

The Academy of Special Needs Planners (ASNP) hosted its Fifth Annual Conference March 11-12, 2011 in San Francisco. Co-chaired by Kevin Urbatsch and Michael Gilfix, the 2011 ASNP conference highlighted a growing knowledge gap between traditional structured settlement consultants (many of whom aspire to be settlement planners) and special needs attorneys (whose professional focus increasing includes settlement planning).

ASNP is one of three national associations of attorneys, the others being the Special Needs Alliance (SNA) and the National Academy of Elder Law Attorneys (NAELA), whose members engage in special needs planning. The primary difference between special needs planning and settlement planning is that special needs planning includes clients whose disabilities result from many causes including but not limited to personal injury or workers compensation accidents.

Beyond the quality of speakers and value of topics, ASNP conferences provide exceptional educational experiences for three additional reasons:

Handout materials - Whereas most speakers at structured settlement conferences provide attendees with a power point handout or no written handout, most ASNP speakers provide attendees with original, topic-specific professional papers (in addition to outlines and/or power points) captured on a digital thumb drive.

Sponsors and Exhibitors - Among the several national conferences S2KM attends, ASNP and NAMSAP provide the best interaction among sponsors, exhibitors and attendees. ASNP's interaction includes designated breaks when attendees are encouraged to meet with sponsors and exhibitors as well as designated tables for sponsors and exhibitors during lunch to promote extended and focused discussions.

Knowledge of Attendees - Because ASNP conference attendees are special needs attorneys who already share a relatively high level of common professional knowledge, ASNP speakers have the freedom to expand the collective knowledge domain of attendees rather than merely reinforce existing shared knowledge.

ASNP's 2011 Speakers and Highlights

Vincent Russo - Alternatives to Special Needs Trusts - Russo, one of ASNP's founders, highlighted planning uncertainties that justify consideration of alternative special needs strategies. In the context of such uncertainties, including life expectancies plus changes in Medicaid and estate tax laws, Russo utilized videotaped case examples to discuss several alternatives to SNTs.

Rafael Gonzales - MSAs and Special Needs Planning - Gonzales' presentation addressed mandatory insurer reporting, conditional payments and Medicare set-aside arrangements. MSA's have become a frequent topic at almost every structured settlement and settlement planning conference - and with good reason given the many and frequent new developments. Gonzales' presentation featured summaries of the most recent case law, regulatory developments and legislative proposals.

David Lillesand - SSI Update - Lillesand's annual Social Security Income summary for ASNP included detailed analysis of Social Security Regional Chief Counsel precedents for 2009 and 2010 some of which impact structured settlements used to fund SNTs. Lillesand also highlighted three new POMs for SNTs. Based upon his review of recent Social Security rulings, Lillesand identified a potential new issue for attorneys - expanded circumstances when legal fees are subject to Social Security approval.

Patricia Dudek - Creative Housing Solutions - Although disabled persons historically have had few options for home ownership, home ownership is now a more realistic possibility according to Dudek. Her presentation summarized existing federal housing programs as well as financial and legal strategies for achieving home ownership for persons with disabilities.

Cynthia Barrett - How Health Care Reform Impacts Persons with Disabilities - Barrett's discussion summarized the new Federal health care legislation and advised ASNP attendees about how to adjust their professional practice. Of special interest to structured settlement and settlement planning professionals, Barrett highlighted and discussed the questions plaintiff attorneys are most likely to ask about health care reform.

David Foster Koth and Gregory Finn - Selecting Corporate Trustees - Among the many issues discussed during this presentation, the portion addressing structured settlement issues was among the best and most interesting. In the context of allocating trust investments among different financial vehicles, the co-presenters provided a balanced perspective on the advantages and disadvantages of structured settlements as well as the role of the secondary structured settlement market.

Ruth Phelps - Community Funded SNTs - When a community establishes a special needs trust, several important planning considerations exist. Phelps used a case example to discuss these issues and offer a model planning solution.

November 07, 2010

The National Structured Settlement Trade Association ( NSSTA ) and the National Association of Settlement Purchasers ( NASP ) have announced agendas and speakers for their 2010 educational conferences scheduled concurrently and coincidentially next week (November 10-12, 2010) in Las Vegas.

S2KM has published an introductory report for these conferences plus historical reporting about past NSSTA and NASP educational conferences. S2KM's Managing Director, Patrick Hindert, will attend portions of the NSSTA conference (as a member) and participate at the NASP conference (as a moderator and speaker).

S2KM recommends both the NSSTA and NASP educational conferences to all structured settlement stakeholders and offers this preliminary comparative analysis.

Topics

NSSTA and NASP will both address several similar issues:

Ethics - NSSTA and NASP could enhance their discussions by addressing "business practices" including the "Standards of Professional Conduct" adopted by the Society of Settlement Planners (SSP) on March 7, 2008.

Life expectancy - hopefully, NSSTA will link this discussion with related Medicare and Medicaid issues. Whatever happened to the structured settlement industry's life expectancy study initiated by Roger Harbin and Steve Smith?

NASP

Industry analysis - NSSTA's educational programs typically provide limited strategic analysis with only one perspective and no outside critics. NASP features more open discussion of strategic industry issues featuring critics and alternative perspectives.

Taxation life cycle - Both NASP and SSP have previously featured Jeremy Babener as a speaker. Why not NSSTA? Babener's NASP presentation promises to be one of the highlights of these two structured settlement educational conferences.

Dodd Frank legislation - a good example of NASP analysis of federal legislation that impacts both the primary and secondary structured settlement markets.

Speakers

NSSTA and NASP speakers both include a mix of association members and non-members. Both associations typically feature judges, attorneys and legislators as speakers. NSSTA's legislative speakers are generally federal while NASP's legislative speakers are generally state.

NSSTA speakers do not include SSP or NASP members. NASP speakers include both NSSTA and SSP members and thereby generate more comprehensive and valuable strategic discussions.